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목적: 황반원공과 당뇨황반부종에서 내경계막 제거에 따른 망막손상에 대해 알아보았다. 대상과 방법: 황반원공 45안, 당뇨황반부종 35안에서 유리체절제술과 내경계막 제거를 시행하였다. 투과전자현미경으로 내경계막 망막면의 미세구조를 관찰하여 망막조직 손상 정도를 조사하였으며, 막 제거 시의 염색, 출혈 및 망막손상 여부와의 연관성을 알아보았다. 결과: 당뇨황반부종(3.13±1.12 μm)의 내경계막은 황반원공(2.41±0.77 μm)에 비해 두꺼웠으며(p=0.002), 두 질환 모두 망막쪽 면에서세포성분이 관찰되었다. 내경계막 벗김 시 망막표면에 출혈이 동반된 경우는 당뇨황반부종(22.9%)에 비해 황반원공(46.7%)에서 많았으며(p=0.028), 벗김에 따른 미세 망막손상은 황반원공(48.9%)과 당뇨황반부종(45.7%) 모두에서 관찰되었고 질환에 따른 빈도 차이를보이지는 않았다(p=0.78). 전체적으로 내경계막 제거 시 망막표면의 출혈이 있었던 경우(62.1%)가 없었던 경우(39.2%)에 비해 망막손상이 많았다 (p=0.049). 결론: 내경계막 제거 시 망막의 미세한 손상을 유발할 가능성이 있으므로 신중한 접근이 필요할 것으로 생각된다.


Purpose: To evaluate retinal damage following internal limiting membrane (ILM) peeling in macular hole and diabetic macular edema (DME) surgeries. Methods: Forty-five eyes with macular holes and thirty-five eyes with DME underwent pars plana vitrectomy with ILM peeling. The structures of the ILM were investigated using transmission electron microscopy, and the grades of retinal tissue damage were analyzed. We additionally observed the clinicopathologic association of retinal damage with the development of retinal hemorrhage during ILM peeling and that seen with indocyanine green (ICG) staining. Results: In all specimens, cellular fragments were observed on the retinal side of the ILM in both macular hole and DME patients. The thickness of the ILM in DME significantly increased (3.13±1.12 μm compared with that in patients with macular holes (2.41±0.77 μm, p=0.002). The frequency of minute retinal bleeding during ILM peeling was higher in macular hole patients (46.7%) than in those with diabetic macular edema (22.9%m p=0.028). Twenty-two eyes of 45 macular hole patients (48.9%) and 16 eyes of 35 DME patients (45.7%) had relative retinal damage. Overall, ILM performed in eyes which had minute bleeding during the peeling had more retinal damage (62.1%) than did those without hemorrhage (39.2%, p=0.049). ICG staining did not appear to influence retinal damage (p=0.81). Conclusions: ILM peeling can cause minor, but demonstrable, damage of the adjacent retina.